The number of doctors in the population doubled between 1971 and 2001, from 122 to 248 per 100,000 population. However, the distribution of doctors is not even across Australia.

General practitioners are the main providers of primary medical care in Australia, and are also responsible for referring patients elsewhere in the health system, in particular to specialists. Specialist practitioners use sophisticated knowledge in particular areas of medicine to diagnose or treat patients. The number of doctors, their distribution, and the balance of general and specialist medical practitioners are basic considerations affecting access to health care, and also impact on doctors’ working conditions. The cost of public funding for medical services provided by doctors is also an issue, particularly as the average number of medical services provided to each person has increased since the Medicare scheme was introduced in 1984.1 In the 1980s and 1990s, concern focused on the availability of general practitioners outside metropolitan areas, while the number of general practitioners in metropolitan areas has been considered to be more than adequate, and to show indications of over-supply.2 Keeping pace with the need for specialists has also been a concern.

DoctorsIn the Census of Population and Housing, medical practitioners (doctors) are identified from information each employed person supplies about the job they had in the week prior to census night, including their occupation and the main tasks performed.

Generalist medical practitioners(General practitioners)diagnose, treat and prevent human physical and mental disorders and injuries; hold a bachelor degree or higher qualification and one year of hospital-based training; and are registered or licensed by state or territory authorities. Counts of general practitioners in this article include interns and other medical practitioners in training, who have completed a medical qualification and work under the supervision of a specialist or a senior general practitioner.

Specialist medical practitioners (Specialists) diagnose and treat physical and mental diseases or disorders using specialist testing, diagnostic, medical and surgical techniques. Medical Registrars who are training as Specialist Medical Practitioners are included in this group.

How many doctors?Over the 30 years to 2001, the number of doctors increased at a much faster rate than the population. As a result, between 1971 and 2001 the number of doctors in the population doubled, from 122 to 248 per 100,000 population. Over this period, the fastest growth was in the 1970s, with the number of doctors per person increasing to 181 per 100,000 population by 1981. Over the 1980s and 1990s the rate of increase slowed, particularly in the five years to 2001, with the 248 doctors per 100,000 population in 2001 only slightly higher than the 241 in 1996. A number of factors may have restrained growth over these five years. The annual number of medical graduates was held relatively stable over the late 1980s and 1990s, in contrast to previous increases. From 1995 onwards, changes were made to training and accreditation for general practice, there were new restrictions on access to Medicare billing rights, and changes to the value of medical qualifications for those seeking to immigrate as skilled migrants, while specialist trainee numbers were gradually increased. These measures were designed to slow the flow of doctors into general practice, in favour of specialist training and hospital positions.

DOCTORS PER 100,000 POPULATION(a)

(a) Estimated resident population at 30 June each year.

Sources: ABS 1971-2001 Censuses of Population and Housing; ABS Estimated resident populations at 30 June 1971-2001.

The long-term increase in the number of doctors has been partly offset by the increased proportion of doctors who work part-time. In 2001, 20% of doctors worked part-time, compared with 8% in 1971. This partly reflects the increased number of women who have taken up medicine as a career. Similar proportions of women doctors worked part-time in 1971 and 2001 (34% and 36% respectively) but this had a greater impact in 2001 when women made up a larger proportion of all doctors (33% compared with 13% in 1971). In addition, it has become more common for male doctors to work part-time: 12% worked part-time in 2001, compared with 4% in 1971.

Doctors in 2001In August 2001, there were 48,200 employed medical practitioners in Australia. About two-thirds were Generalist medical practitioners (including 2,760 medical graduates who were working as general practitioners in supervised positions). Of the 15,900 Specialists, Surgeons (3,270) and Anaesthetists (2,140) were the largest groups separately identified in the census.

DOCTORS: OCCUPATIONS - 2001

Doctors

Proportion who were female

Doctors per 100,000 people

Occupational groups

no.

%

rate

Generalist medical practitioner

32,000

35.9

164.8

Medical practitioner in training

2,758

46.2

14.2

Specialist medical practitioner

15,875

26.3

81.8

Anaesthetist

2,140

24.3

11.0

Dermatologist

240

37.9

1.2

Emergency medicine specialist

327

32.7

1.7

Obstetrician & gynaecologist

796

28.1

4.1

Ophthalmologist

438

21.0

2.3

Paediatrician

795

40.3

4.1

Pathologist

1,147

48.1

5.9

Specialist physician

1,934

22.6

10.0

Psychiatrist

2,010

36.1

10.4

Radiologist

1,376

24.3

7.1

Surgeon

3,269

8.1

16.8

Other

497

38.2

2.6

Total(a)

48,211

32.7

248.3

(a) Includes 336 Medical practitioners who were not classifiable as general practitioners or specialists.

Source: ABS 2001 Census of Population and Housing.

...personal characteristicsThe median age of doctors was 43 years (i.e. one-half of all doctors were older than this age). One-quarter of all doctors were aged less than 35 years and three-quarters were aged less than 53 years. However, the age pattern varied between men and women. Female doctors were generally younger than male doctors, with a median age of 39 years compared with 45 years for males. Women constituted 46% of all doctors aged less than 35 years, decreasing to 10% of those aged 65 years and over. This age pattern largely reflects the fact that an increasing number of female graduates have entered the profession over the last two decades: reaching 48% of those graduating from bachelor level courses in medicine in 1999.3

DISTRIBUTION OF DOCTORS BY AGE AND SEX - 2001

Source: ABS 2001 Census of Population and Housing.

Women made up a smaller proportion of Specialists (26%) than of General practitioners (36%). The most common female specialists were Psychiatrists (730), Pathologists (550) and Anaesthetists (520). The most common male specialists were Surgeons (3,000), Anaesthetists (1,600) and Specialist physicians (1,500). The proportion of specialists who were female ranged from 8% for Surgeons to 48% for Pathologists.

In 2001, 43% of doctors in Australia had been born overseas, compared with 22% of the total population. Doctors born overseas have increased as a proportion of all doctors since 1971, when they accounted for 31%. Overseas-born doctors include those who study medicine after migrating to Australia and those who train in medicine overseas and subsequently migrate. In 1998 about one-fifth of employed medical practitioners in Australia had gained their initial medical qualification overseas and of these, 96% were Australian citizens or permanent residents.2

In addition to doctors who immigrate, doctors with temporary resident visas come to Australia for periods of one or two years under a program designed to allow State health authorities to augment their doctor workforces, and especially to staff positions which are difficult to fill. In general, temporary resident doctors fill hospital positions, or work in general practice in rural areas. The number of temporary resident doctors entering Australia each year increased markedly over the 1990s, from 670 in 1992-93 to 2,370 in 1999-2000, and as at 30 June 2002 there were an estimated 2,900 such doctors working in Australia.3,4

...working arrangementsGeneral practitioners, as defined in the census, do not necessarily all work in General practice medical services, although 63% did in 2001, while 24% worked in Hospitals (excluding psychiatric hospitals). Specialists most commonly worked in Specialist medical services (34%) and in Hospitals (excluding psychiatric hospitals) (30%), but also in General practice medical services (14%) with the remainder in other health related services.

SELECTED CHARACTERISTICS(a) OF DOCTORS - 2001

Males

Females

Persons

%

%

%

Industry

General practice medical services

47.1

46.2

46.8

Specialist medical services

15.0

7.1

12.4

Hospitals (excluding psychiatric hospitals)

24.0

30.4

26.1

Pathology services

0.9

1.9

1.2

Community health centres

0.8

1.2

1.0

Other

12.3

13.1

12.6

Hours worked(b)

Part-time (less than 35 hours per week)

11.8

35.8

19.6

Full-time doctors working long hours

Worked 50 hours or more per week

64.9

44.0

59.5

Worked 70 hours or more per week

14.3

7.6

12.5

Weekly gross personal income from all sources

$1-799

6.4

18.4

10.3

$800-999

6.1

13.3

8.5

$1,000-1,499

18.1

29.7

21.9

$1,500 or more

69.3

38.6

59.3

Total(a)

100.0

100.0

100.0

(a) Doctors whose answers to census questions on industry, hours worked or weekly income were not stated or inadequately described were excluded prior to the calculation of the relevant percentages.(b) Based on hours worked in the two weeks to census night 2001. Doctors who were employed but did no work in those two weeks (for example, those on leave) were excluded prior to the calculation of percentages.

Source: ABS 2001 Census of Population and Housing.

Doctors tend to work longer hours than people employed in many other occupations. In 2001, they worked a median of 48 hours per week, compared with a median of 40 hours per week for all employed people. Doctors had higher median hours than most other Professional occupations (see Australian Social Trends 2003, Longer working hours). Medical practitioners working in Hospitals (excluding psychiatric hospitals) had a median of 50 hours per week, as did those working in Specialist medical services. Those working in General practice medical services had somewhat lower median hours of 45 hours per week, partly reflecting the number of women in General Practice (the median was 50 hours per week for men in General Practice compared with 35 hours per week for women).

Many full-time doctors worked more than 50 hours a week (59%). This included 13% of full-time doctors who worked 70 hours a week or more in August 2001. Males who were full-time tended to work longer hours than females who were full-time. For example, 65% of male full-time doctors worked 50 hours or more per week, compared with 44% of female full-time doctors.

Three-quarters of specialists and just over one-half of general practitioners earned $1,500 per week or more (the highest income bracket recorded in the 2001 Census). In total, 59% of doctors were in this bracket, compared with 13% of all Professionals and 23% of Managers and Administrators.

Geographic distributionAlthough not all doctors work in the same area in which they live, the number of general practitioners and specialists living in Remoteness Areas are an indication of the number of doctors available per person in those areas. In 2001, 80% of doctors lived in Major Cities, compared with 67% of the Australian population. This distribution meant that there were more doctors per person living in Major Cities than was the case elsewhere in Australia. For example, in Major Cities there were 308 doctors per 100,000 population, 76% higher than the 175 doctors per 100,000 population in Inner Regional areas. Rates for other areas were lower and decreased with increasing remoteness, to 77 per 100,000 population in Very Remote areas. Access to health services in remote areas is affected by the sparse distribution of doctors and their patients, which increases patients’ travelling times and makes transport essential in order to access medical services. In addition, the range of specialist treatment facilities in remote areas is more limited.

The rates above are based on the usual residence of doctors. However, to help meet the health needs of people who live in more remote areas, locums and specialists travel to more remote areas both as need arises and as part of a regular rotation between centres. This work-related travelling of doctors, together with travel for personal reasons (such as holidays), means that the numbers of doctors actually located in Remoteness Areas on census night differs from the number who live there. For example, 196 doctors were in Very Remote areas on census night (excluding some who did not work in the previous two weeks and therefore appear most likely to be travelling for personal reasons), 54% more than the number who usually lived there. Taking these non-residents into account produces rates which range from 299 doctors per 100,000 usual resident population in Major Cities to 119 per 100,000 population in Very Remote areas, and reduces the difference between rates across Remoteness Areas compared with taking only usual resident doctors into account.

DOCTORS PER 100,000 POPULATION(a) BY REMOTENESS AREA - 2001

(a) Usual resident population at Census 2001.(b) Doctors were classified to a Remoteness Area on the basis of the location of their usual residence.(c) Doctors were classified to a Remoteness Area on the basis of their actual location on census night. Excludes those doctors who were not at their usual residence on census night and had also not performed any work in the previous two weeks or did not state any hours worked.

Source: ABS 2001 Census of Population and Housing.

USUAL RESIDENT DOCTORS AND THOSE LOCATED IN REMOTENESS AREAS ON CENSUS NIGHT(a) - 2001

Usual resident of area

Located in area on census night

Remoteness Area

no.

no.

Major Cities

38,412

37,256

Inner Regional

6,691

6,931

Outer Regional

2,632

3,055

Remote

349

422

Very remote

127

196

(a) Excludes doctors who were not at their usual residence on census night and had also not performed any work in the previous two weeks or did not state any hours worked.

Source: ABS 2001 Census of Population and Housing.

Remoteness AreasThis article uses the ABS Remoteness Classification to examine the characteristics of doctors in the six Remoteness Areas. Remoteness is calculated using the road distance to different sized urban centres, where the population size is considered to govern the range and type of services available. Except where otherwise specified, in this article doctors have been classified to Remoteness Areas based on the location of their usual residence (the address at which they were living or expected to live for a total of six months or more in 2001). The six Remoteness Areas are: Major Cities of Australia; Inner Regional Australia; Outer Regional Australia; Remote Australia; Very Remote Australia and Migratory. The Remoteness Area names used in this article are abbreviated versions of these official names with ‘Australia’ omitted. For further information see Statistical Geography: Volume 1 - Australian Standard Geographical Classification (ASGC), 2001(ABS cat. no. 1216.0).

Characteristics of doctors living in different Remoteness Areas The geographic distribution of general practitioners, who mostly provide primary care, is different from that of specialists. Specialists tend to be located in hospitals in Major Cities, and to a lesser extent Inner and Outer Regional areas, where the population supports other complementary expert medical services, appropriate medical technology and provides a sufficient flow of patients with the relevant health needs. Specialists made up 35% of doctors living in Major Cities, but this proportion decreased steadily with increasing remoteness, to be 6% of doctors in Very Remote areas.

SELECTED CHARACTERISTICS OF DOCTORS(a) BY REMOTENESS AREAS - 2001

Major Cities

Inner Regional

Outer Regional

Remote

Very Remote

%

%

%

%

%

Female

33.9

27.2

30.4

31.2

33.1

Occupational group

Generalist medical practitioner

64.6

71.0

76.4

83.4

93.7

Medical practitioner in training

6.0

4.4

3.9

6.9

6.3

Specialist medical practitioner

34.7

28.5

23.1

15.5

5.5

Industry

General practice medical services

43.7

58.3

59.4

54.9

53.5

Specialist medical services

12.7

12.5

8.9

3.7

-

Hospital (excluding psychiatric)

28.7

15.6

17.0

21.8

18.1

Pathology services

1.2

1.3

1.1

0.6

-

Community health centres

1.0

0.7

0.8

1.7

6.3

Other

12.7

11.5

12.8

17.2

22.0

Hours worked

Part-time (less than 35 hours per week)

20.0

19.2

16.9

10.6

10.2

Full-time doctors who worked long hours

50 hours or more per week

58.4

63.2

62.5

63.4

74.5

70 hours or more per week

11.4

15.9

18.3

19.9

23.6

Weekly gross personal income from all sources $1,500 or more

58.1

63.3

64.2

66.4

80.5

no.

no.

no.

no.

no.

Total

38 412

6 691

2 632

349

127

(a) Doctors were classified to a Remoteness Area on the basis of the location of their usual residence.

Source: ABS 2001 Census of Population and Housing.

Outside of Major Cities, doctors tended to work longer hours, and to have higher incomes as remoteness increased. Hours worked per week increased with remoteness from a median of 46 hours in Major Cities to 55 hours in Very Remote areas. This partly reflects the fewer doctors working part-time outside Major Cities: the proportion of doctors who worked part-time decreased with remoteness from 20% in Major Cities to 10% in Very Remote areas. In addition, the proportion of full-time doctors who worked 50 hours or more a week increased with remoteness from 58% in Major Cities to 75% in Very Remote areas. Consistent with these longer hours, and with other factors, including the higher proportion of doctors in Major Cities who are salaried hospital staff rather than private practitioners, doctors’ incomes tended to be higher in areas outside of Major Cities. In Major Cities, 58% of doctors earned $1,500 or more per week, compared with 81% of doctors in Very Remote areas.

There were also demographic differences between doctors in different geographic areas. People aged less than 35 years made up 17% of doctors in Inner and Outer Regional areas compared with 27% in Major Cities and 25% in Remote and Very Remote areas. In contrast, in Inner and Outer Regional areas relatively more doctors were aged 45-54 years (30%) than was the case in Major Cities (24%) or in Remote and Very Remote areas (23%). In 2001, women made up 27% of doctors in Inner Regional areas, 34% in Major Cities, and from 31% to 33% elsewhere.

Overseas-born doctors made up a lower proportion of doctors in Inner Regional areas (35%) than in Major Cities (44%) and Outer Regional areas (44%). However, the proportion of doctors who were born overseas was highest in Remote areas (56%) and Very Remote areas (51%).

In all Remoteness Areas, General and Specialist medical services and Hospitals (excluding psychiatric hospitals) together accounted for the employment of most doctors. Nevertheless there were some differences between areas in the industries in which doctors worked. These reflected the locations of hospitals, community health centres and other organisations. In Major Cities a greater proportion of all doctors worked in Hospitals (29%) than was the case elsewhere. In regional areas, higher proportions of doctors were in General practice or Specialist medical services (71% in Inner Regional areas and 68% in Outer Regional areas) than was the case elsewhere. In Very Remote areas 6% of doctors were employed in Community health centres compared with 1 to 2% of doctors elsewhere.

Educated in medicine but not working as doctorsThere were 17,600 people counted in the 2001 Census who stated that they had a bachelor degree or higher qualification in medical studies as their highest qualification but who were not working as doctors. Just over half were not in the labour force (52%), while 44% were working in another occupation and the remainder were unemployed. More than half of the 9,050 who were not in the labour force were aged 65 years or over (55%). Of the remaining 4,070 people, who were not in the labour force and less than 65 years, 61% were women and 39% men.

Of the 7,790 medical graduates who were working, but not as doctors, some were Health Professionals other than doctors (1,380 people), Medical scientists (570 people), or Health service managers (220 people), but most were in occupations apparently unrelated to medicine (5,450).